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Nurse Licensure Examination Review

Nurse Licensure Examination Review. Diabetes Mellitus. Diabetes Mellitus. A group of metabolic diseases characterized by elevated levels of glucose in the blood resulting from defects in insulin secretion, insulin action, insulin receptors or any combination of conditions. Diabetes Mellitus.

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Nurse Licensure Examination Review

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  1. Nurse Licensure Examination Review Diabetes Mellitus

  2. Diabetes Mellitus • A group of metabolic diseases characterized by elevated levels of glucose in the blood resulting from defects in insulin secretion, insulin action, insulin receptors or any combination of conditions.

  3. Diabetes Mellitus • A chronic disorder of impaired glucose metabolism, protein and fat metabolism

  4. Diabetes Mellitus • BASIC PATHOLOGY : Insulin problem (deficiency or impaired action)

  5. Diabetes Mellitus • Insulin is a hormone secreted by the BETA cells of the pancreas • Stimulus of insulin- HYPERGLYCEMIA

  6. Diabetes Mellitus • Action of insulin: it promotes entry of Glucose into the body cells by binding to the insulin receptor in the cell membrane

  7. INSULIN : Physiology Insulin Metabolic Functions: • 1. Transports and metabolizes GLUCOSE • 2. Promotes GLYCOGENESIS • 3. Promotes GLYCOLYSIS • 4. Enhances LIPOGENESIS • 5. Accelerates PROTEIN SYNTHESIS

  8. Diabetes Mellitus RISK FACTORS for Diabetes Mellitus • 1. Family History of diabetes • 2. Obesity • 3. Race/Ethnicity

  9. Diabetes Mellitus RISK FACTORS for Diabetes Mellitus • 4. Age of more than 45 • 5. Previously unidentified IFG/IGT • 6. Hypertension

  10. Diabetes Mellitus RISK FACTORS for Diabetes Mellitus • 7. Hyperlipidemia • 8. History of Gestational Diabetes Mellitus

  11. Diabetes Mellitus CLASSIFICATION OF DM 1. Type 1 DM • Insulin dependent Diabetes Mellitus 2. Type 2 DM • Non-insulin dependent Diabetes Mellitus 3. Gestational DM • Diabetes Mellitus diagnosed during pregnancy 4. DM associated with other conditions or syndromes

  12. Diabetes Mellitus CLASSIFICATION OF DM 1. Type 1 DM • Insulin dependent Diabetes Mellitus

  13. Diabetes Mellitus CLASSIFICATION OF DM 2. Type 2 DM • Non-insulin dependent Diabetes Mellitus

  14. Diabetes Mellitus CLASSIFICATION OF DM 3. Gestational DM • Diabetes Mellitus diagnosed during pregnancy

  15. Diabetes Mellitus CLASSIFICATION OF DM 4. DM associated with other conditions or syndromes

  16. Diabetes Mellitus Other types of DM • 1. Impaired Glucose Tolerance • 2. Impaired Fasting Glucose • 3. Pre-diabetes

  17. TYPE 1- Diabetes Mellitus This type of DM is characterized by the destruction of the pancreatic beta cells

  18. TYPE 1- Diabetes Mellitus Etiology: 1. Genetic susceptibility- HLA DR3 and DR4 2. Autoimmune response 3. Toxins, unidentified viruses and environmental factors

  19. TYPE 1- Diabetes Mellitus PATHOPHYSIOLOGY • Destruction of BETA cells decreased insulin production  uncontrolled glucose production by the liver hyperglycemia  signs and symptoms

  20. TYPE 1- Diabetes Mellitus PATHOPHYSIOLOGY CLASSIC P’s • Polyuria • Polydipsia • Polyphagia

  21. TYPE 2- Diabetes Mellitus • A type of DM characterized by insulin resistance and impaired insulin production

  22. TYPE 2- Diabetes Mellitus Etiology: 1. Unknown 2. Probably genetic and obesity

  23. TYPE 2- Diabetes Mellitus PATHOPHYSIOLOGY • Decreased sensitivity of insulin receptor to insulin  less uptake of glucose  HYPERGLYCEMIA

  24. TYPE 2- Diabetes Mellitus PATHOPHYSIOLOGY • Decreased insulin production  diminished insulin action  hyperglycemia  signs and symptoms

  25. TYPE 2- Diabetes Mellitus PATHOPHYSIOLOGY • BUT (+) insulin in small amount  prevent breakdown of fats  DKA is unusual

  26. GESTATIONAL Diabetes Mellitus • Any degree of glucose intolerance with its onset during pregnancy • Usually detected between 24-28th week gestation

  27. GESTATIONAL Diabetes Mellitus • Blood glucose returns to normal after delivery of the infant • NEVER administer ORAL HYPOGLYCEMIC AGENTS to PREGNANT MOTHERS!

  28. Diabetes Mellitus ASSESSMENT FINDINGS • 1. Classic 3 P’s • 2. Fatigue • 3. Body weakness

  29. Diabetes Mellitus ASSESSMENT FINDINGS • 4. Visual changes • 5. Slow wound healing • 6. Recurrent skin and mucus membrane infections

  30. Diabetes Mellitus DIAGNOSTIC TESTS • 1. FBS- > 126 • 2. RBS- >200 • 3. OGTT- > 200

  31. Diabetes Mellitus DIAGNOSTIC TESTS • 4. HgbA1- for monitoring!! • 5. Urine glucose • 6. Urine ketones

  32. Diabetes Mellitus DIAGNOSTIC CRITERIA • 1. FBS equal to or greater than 126 mg/dL (7.0mmol/L) • (Normal 8 hour FBS- 80-109 mg/dL)

  33. Diabetes Mellitus DIAGNOSTIC CRITERIA • 2. OGTT value 1 and 2 hours post-prandial equal to or greater than 200 mg/dL • Normal OGTT 1 and 2 hours post-prandial- is • 140 mg/dL

  34. Diabetes Mellitus DIAGNOSTIC CRITERIA • 3. RBS of equal to or greater than 200 mg/dL PLUS the 3 P’s

  35. Diabetes Mellitus NURSING MANAGEMENT OF DM • The main goal is to NORMALIZE insulin activity and blood glucose level by:

  36. Diabetes Mellitus NURSING MANAGEMENT OF DM 1. Nutritional modification 2. Regular Exercise 3. Regular Glucose Monitoring 4. Drug therapy 5. Client Education

  37. Diabetes Mellitus The Patient with DM • HISTORY • Symptoms and characteristics • PHYSICAL EXAMINATION • VS, BMI, Fundoscopy, Neuro • LABORATORY EXAMINATION • FBS, RBS, HgbA1c, lipid profile, ECG, UA • REFERRALS • Ophthalmologist, Podiatrist, Dietician, etc..

  38. Diabetes Mellitus The Patient with DM • HISTORY • Symptoms and characteristics • PHYSICAL EXAMINATION • VS, BMI, Fundoscopy, and Neuro assessment

  39. Diabetes Mellitus The Patient with DM • LABORATORY EXAMINATION • FBS, RBS, HgbA1c, lipid profile, ECG, and Urinalysis • REFERRALS • Ophthalmologist, Podiatrist, Dietician, etc..

  40. DM Nutritional management

  41. Diabetes Mellitus NUTRITIONAL MANAGEMENT • 1.Review the patient’s diet history to identify eating habits and lifestyle • 2. Coordinate with the dietician in meal planning for weight loss

  42. Diabetes Mellitus NUTRITIONAL MANAGEMENT • 3. Plan for the caloric intake distributed as follows- CHO 50-60%; Fats 20-30%; and Proteins 10-20% • 4. Advise moderation in alcohol intake • 5. Using artificial sweeteners is acceptable

  43. DM Exercise management

  44. Diabetes Mellitus EXERCISE Management • 1. Teach that exercise can lower the blood glucose level • 2. Diabetics must first control the glucose level before initiating exercise programs.

  45. Diabetes Mellitus EXERCISE Management • 3. Offer extra food /calories before engaging in exercise • 4. Offer snacks at the end of the exercise period if patient is on insulin treatment.

  46. Diabetes Mellitus EXERCISE Management • 5. Advise that exercise should be done at the same time every day, preferably when blood glucose levels are at their peak

  47. Diabetes Mellitus EXERCISE Management • 6. Regular exercise, not sporadic exercise, should be encouraged. • 7. For most patient, WALKING is the safe and beneficial form of exercise

  48. Glucose Self Monitoring

  49. Diabetes Mellitus GLUCOSE MONITORING • Self-monitoring of blood glucose (SMBG) enables the patient to adjust the treatment regimen to obtain optimal glucose control

  50. Diabetes Mellitus GLUCOSE MONITORING • Most common method involves obtaining a drop of capillary blood applied to a test strip. • The usual recommended frequency is TWO-FOUR times a day.

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